Radisson Blu Scandinavia Hotel Amager Boulevard 70, København Tlf. 3396 5000
DASAIMs Årsmøde 11-13 november 2010
nsk Selskab for Anæstesiologi og Intensiv Medicins Årsmød
Beliggenhed: Radisson Blu Scandinavia Hotel ligger ca. 1 km fra Københavns Hovedbanegård.
Fly: Den nærmeste lufthavn er Københavns Lufthavn, som ligger ca. 8 km fra hotellet.
Metro-station: Islands Brygge.
Bil: Få kørselsvejledning på www.radissonblu.dk/scandinaviahotel-koebenhavn Parkering: Vær opmærksom på, at der er parkeringsafgift på området!
Kongresområdet
Trafik-info
Hovedsponsorer DASAIMs årsmøde 2010
Den stigende interesse for samarbejdet mellem læger og lægemiddelvirksomheder er ikke forbigået vores opmærk- somhed, og vi har derfor anmeldt arrangementet til Nævnet for Selvjustits på Lægemiddelområdet. Dette nævn har til for- mål at sikre overholdelse af den indgåede samarbejdsaftale mellem Lægeforeningen og virksomhederne. Det fremgår heraf, at firmaerne kun må yde støtte til den faglige del af mødet, som f.eks. mødelokaler og dækning af de udenland- ske foredragsholderes udgifter. Heldigvis har DASAIM i årevis haft det princip, at alle medlemmer betaler for deltagelsen, og at det sociale program betales særskilt.
Vi glæder os til at se jer.
Steen Møiniche, Lars Rasmussen og Tina Calundann
Arrangementet er anmeldt til - men ikke nødvendigvis godkendt af - NSL (Nævnet for Selvjustits på Lægemiddelområdet), og NSL’s sekretariat har haft lejlighed til at gennemgå anmeldelsen. Nævnet har ikke på det foreliggende haft bemærkninger til arrangementet, og arrangementet er, efter arrangørens opfattelse, i overensstemmelse med reglerne i samarbejdsaftalen.
Sponsorerne har ingen indflydelse på indholdet i de videnskabelige sessioner.
Velkommen til DASAIMs årsmøde 2010
Efter et meget lille møde 2009 kan vi nu byde jer velkommen til et årsmøde, der igen består af 3 dage med forelæsninger, parallelsessioner, posterpræsentationer og foredragskonkur- rence. Acta Anaesthesiologica Scandinavica sponsorerer igen præmierne til foredragskonkurrencen med en 1., .2. og 3.
præmie. Derudover har vi en publikumsprisen samt en pris for bedste poster. Novo Nordisk giver igen i år Innovationsprisen til en yngre forsker, hvis abstract udmærker sig ved innovativ tankegang. De heldige modtagere af ovennævnte præmier og priser vil være at finde blandt de 36 indsendte abstracts.
DASAIMs bestyrelse og udvalg har sammen med organisa- tionskomiteen sammensat programmet, der udover faglig op- datering også giver mulighed for uformel diskussion i pauser og ved måltider - ikke mindst ved festmiddagen fredag. Vi vil gerne takke de mange, der stiller op som foredragsholdere og moderatorer, men også sponsorer og udstillere, hvis støtte giver et solidt økonomisk fundament for dette arrangement.
Torsdag d. 11. november
08.00 - Registrering
09.00 - 10.00 Finland + Norway Room
Den 2. Henning Ruben-forelæsning
Ultralyd her, dér og alle vegne - Hør! Hvad fanden er meningen?
v/ Erik Sloth Moderator:
10.00 - 10.30 Udstilling - kaffe 10.30 - 11.00 Sweden Room
Central lungeemboli - patofysiologi og behandlingsmuligheder v/ Benedict Kjærgaard
Moderator: Helle Laugesen Norway Room
Kan alle patienter opereres i dagkirurgisk regi?
v/ Sven Felsby og Ulf Thyge Larsen Moderator: Mette Hyllested Finland Room
Akutlægehelikopter
v/ Annemarie Bondegaard Thomsen Moderator: Matthias Giebner Iceland Room
Lokal infiltrationsanalgesi til hofte- og knæalloplastik v/ Lasse Østergaard Andersen
Moderator: Jonna Storm Fomsgaard
11.00 - 12.00 Udstilling - sandwich/vand i udstillingsområdet
11.00 - 12.00 Bag posteren - se den nye danske forskning og mød forskeren bag posteren 12.00 - 13.30 Sweden Room
Anæstesi til organtransplantation, donoroperationer og transplanterede patienter, del I - Donorterapi - en funktionel tilgang v/ Pernille Haure
- Anæstesi til donoroperation v/ Annette Ulrich Moderatorer: Karsten Bülow og Inge Severinsen Norway Room
Anæstesiologen i verdens brændpunkter
- Hvilke opgaver løser det danske felthospital? v/ Jens Tingleff
- Erfaringer fra arbejdet i udlandet som anæstesiolog i Forsvaret v/ Jesper Dirks - Forskelle og ligheder mellem det civile og militære arbejde v/ Niels Kim Schønemann Moderator: Lars S. Rasmussen
Denmark Room
Perioperativ væske - hvad nyt?
v/ Morten Bundgaard, Henrik Kehlet, Niels H. Secher og Birgitte Brandstrup Moderator: Frank Pott
Iceland Room Neonatal hjerneskade
- Hypotermibehandling efter neonatal asfyksi v/ Gorm Greisen - Neurotoksisitet og anæstesi v/ Tom G. Hansen
Moderator: Torsten Lauritsen 13.30 - 14.00 Udstilling - kaffe
Torsdag d. 11. november fortsat
14.00 - 15.30 Norway Room Posterdiskussion 1
Moderatorer: Erika F. Christensen og Jacob Steinmetz
Abstract nr.
4 Bornholm redder liv – når et helt ø-samfund engageres i hjerte-lunge-redning v/ Anne Møller Nielsen et al
24 Simulation based teaching of paramedics in endotracheal intubation v/ Malene S. Nielsson et al
5 Opfylder øst - og midtjyske akutbilslæger de uddannelsesmæssige rekommandationer fra DASAIM? v/ Leif Rognås et al
J Prehospital treatment of opioid overdose – is it safe to release on-scene?
v/ Søren S. Rudolph et al
E Lægeledsagede interhospitale transporter fra 2006 til 2009 i Region H, planlægningsområde Nord v/ Charlotte Barfod et al
K Endotracheal intubation by using the Airtraq on patients with cardiac arrest handled by paramedics v/ Jacob Madsen et al
F The distribution of triage categories and the impact of emergency symptoms and signs on the triage level. v/ Charlotte Barfod et al
Finland Room Posterdiskussion 2
Moderatorer: Karsten Skovgaard Olsen og Ann Møller
Abstract nr.
3 The Mcgrath videolaryngoscope vs. The Macintosh laryngoscope – a comparative study v/ Jesper Schriver et al
8 Onset time and hemodynamic response after induction with Thiopental versus Propofol in elderly v/ Martin Kryspin Sørensen et al
20 The use of premedication in Danish public Anaesthesiological departments Spring 2010 v/ Hanne M. Hansen et al
17 Tracheal tube and laryngeal mask cuff pressure during anaesthesia – mandatory monitoring is in need. v/ Kim Z. Rokamp et al
G Infrared thermography after selective ultrasound-guided peripheral nerve blocks in the upper extremity. v/ Semera Asghar et al
23 Temporal Comparison of Ultrasound vs. Auscultation and Capnography in Verification of Endotracheal Tube Placement. v/ Peter Pfeiffer, Søren S. Rudolph et al
B Fra et individuelt til et fælles luftvejskoncept v/ Per Henrik Lambert et al
Sweden Room Posterdiskussion 3
Moderatorer: Jørgen B. Dahl og Lone Nikolajsen
Abstract nr.
A Dansk Anæstesi Database Dynamisk (DADDY) v/ Per Henrik Lambert et al
19 Ortostatic intolerance during early mobilization after total hip arthroplasty v/ Øivind Jans et al
12 Blood transfusion guided by Thrombelastography/-metry reduces blood loss and the proportion of patients receiving transfusion - a metaanalysis. v/ Anne Wikkelsø et al
C Pregabalin and dexamethasone improves postoperative pain treatment after tonsillectomy v/ Ole Mathiesen et al
H Do patients want the opportunity to receive treatment with acupuncture for postoperative nausea and pain. v/ Sofie A. Andersen et al
18 Preoperative assessment of cardiac function by speckle tracking ultrasound v/ Christian A. Frederiksen et al
10 Effect of mobilization on acute pain and nociceptive function after total knee arthroplasty v/ Troels H. Lunn et al
25 The use of steroid in the analgesic and atiemetic management of paediatric tonsillectomy v/ Malene S. Nielsson et al
Torsdag d. 11. november fortsat
14.00 - 15.30 Denmark Room (fortsat) Posterdiskussion 4
Moderatorer: Anders Perner og Kirsten Møller
Abstract nr.
6 Acidose i perifert venøst blod øger risikoen for længere indlæggelsesforløb,
overflyttelse til intensiv afdeling samt død hos akut indlagte patienter. v/ Charlotte Barfod et al 16 The Hemodynamic Effect of Pleural Effusion- Evaluated in a Porcine Model
v/ Kristian B. Wemmelund et al
22 Hemorrhagic shock and pulmonary dysfunction: treatment with Adenocaine v/ T.K. Nielsen et al
D Predictors of outcome in SAH: A prospective analysis v/ Peter Martin Hansen et al
I Brandsårspatienter indlagt på intensiv afdeling v/ Rasmus Berthelsen et al
7 The combination of adenosine and lidocaine (adenocaine) improves postresuscitation cardiac function following cardiac arrest. v/ Asger Granfeldt et al
15 Hypoxic ardiac arrest resembles echocardiographic indices of pulmonary embolism in a porcine model. v/ Peter Juhl-Olsen et al
21 Effekten af levosimendan på hjertekirurgiske patienter - et retrospektivt studie v/ Karen Bonde Christiansen et al
15.30 - 16.00 Udstilling - kaffe + frugt eller lign.
16.00 - 17.30 Denmark Room
FYA-symposium: Konflikten i Gaza set gennem en anæstesiologs øjne v/ Mads Gilbert
Moderator: Øivind Jans Norway Room
DAO Generalforsamling Finland Room
Forskningsinitiativet
- Damir Obad; Frigivelse af endorphiner ved remote iskæmisk prækonditionering (rIPC) hos hjertekirurgiske patienter med og uden diabetes mellitus
- Jens K. Rolighed Larsen; Role of Sevoflurane-restricted Mitochondrial Respiration in the Prevention of Cardiomyocyte Oxidative Stress and Ischemic Necrotic Injury
- Morten Bundgaard-Nielsen; Perioperative goal-directed fluid management - methodological and outcome aspects
- Jannie Bisgaard Stæhr; Hæmodynamisk optimering ved international kongres - Christoffer Sølling; Immunmodulerende effekt af erythropoietin (EPO) - Asger Granfeldt; Blødningsshock - behandling med Adenosin/Lidokain Moderator: Palle Toft
Sweden Room
Anæstesi til organtransplantation, donoroperationer og transplanterede patienter, del II Anæstesi til organtransplantation og til patienter, der tidligere er transplanterede v/ Lars Willy Andersen, Carsten Tollund og Birgitte Ruhnau
Moderator: Hans Kirkegaard 17.30 - 19.00 Middag - Casino BallRoom 19.00 - 22.30 Norway + Finland Room
DASAIM Generalforsamling
Fredag d. 12. november
Ambu A/S inviterer til morgenmadssymposium fredag d. 12. november 2010, kl. 08.00 - 09.00
Luftvejshåndtering med fleksible optiske skoper:
Nutid og fremtid
Overlæge Michael Seltz Kristensen, Rigshospitalet
Morgenmadssymposiet afholdes i Denmark Room på Radisson Blu Scandinavia Hotel, København, i forbindelse med DASAIMs årsmøde. Der vil være morgenmad i tilknytning til symposiet.
Deltagelse er gratis for deltagerne i årsmødet, men tilmelding er nødvendig (se tilmeldingsblanket).
Norpharma A/S inviterer til frokostsymposium fredag d. 12. november 2010, kl. 12.00 - 12.45
Er der forskel på opioider?
Resultater fra dansk smerteforskning
og kliniske betragtninger om det postoperative forløb
Opioiders differentierede effekt. v/ Lars Arendt-Nielsen, professor, dr.med., ph.d, Institut for Sundhedsvidenskab og Teknologi, Ålborg Universitet Postoperativ smertelindring med opioider. v/ Johan Ræder, professor i
anæstesiologi, Oslo Universitetssykehus - Ullevål, Oslo
Frokostsymposiet afholdes i Denmark Room på Radisson Blu Scandinavia Hotel, København, i forbindelse med DASAIMs årsmøde. Der vil være frokost i tilknytning til symposiet.
Deltagelse er gratis for deltagerne i årsmødet, men tilmelding er nødvendig (se tilmeldingsblanket).
Fredag d. 12. november
07.30 - Registrering 08.00 - 08.30 Norway Room
Rapid sequence induction in children v/ Markus Weiss
Moderator: Torsten Lauritsen Sweden Room
The Cleveland interpretation of the ASA score v/ Rafi Avitsian
Moderator: Karsten Bülow Finland Room
Sundhedsfagligt beredskab ved store arrangementer v/ Susanne Wammen
Moderator: Charlotte Barfod Iceland Room
Lungeskade ved koronar bypass v/ Bodil Steen Rasmussen Moderator: Claus Andersen 08.00 - 09.00 Denmark Room
Morgenmadssymposium - Ambu 08.30 - 09.00 Udstilling - kaffe
09.00 - 09.30 Norway Room
SSAI position paper - har specialet en fremtid?
v/ Ole Nørregaard
Moderator: Hans Kirkegaard
Forud for - og umiddelbart efter - sessionen “Interhospitale transporter”
inviterer Falck til ...
Interhospital transport: Hvornår og hvordan?
Med fremvisning af køretøj til løsning af opgaven
12. november 2010, kl. 08.30 - 10.00 og 12.00 - 13.00
på parkeringspladsen foran hotellet
Fredag d. 12. november fortsat
09.00 - 09.30 Sweden Room
(fortsat) Interhospitale transporter v/ Charlotte Barfod Moderator: Peter A. Berlac Iceland Room
Spinal opioids - a review of the literature v/ Geana Kurita
Moderator: Luana L. Jensen Finland Room
Diagnose, visitation og behandling af CO-forgiftning v/ Erik C. Jansen
Lars S. Rasmussen 09.30 - 10.00 Udstilling - kaffe
10.00 - 12.00 Sweden, Finland og Norway Room
ACTA foredragskonkurrence - sponseret af Acta Anaesthesiologica Scandinavica Bedømmere: Jørgen B. Dahl, Palle Toft og Erik Sloth
Moderator: Else Tønnesen
Abstract nr.
11 Local infiltration analgesia for acute pain relief in hip arthroplasty: Do we need it?
A randomized, double-blind, placebo-controlled trial in 120 patients v/ Troels H. Lunn et al
1 Intubation in morbidly obese patients. A randomised controlled study comparing the Glidescope®
videolaryngoscope and Macintosh direct laryngoscope v/ Lasse Høgh Andersen et al
14 Postoperative sleep disturbances after fast-track hip and knee replacement v/ Lene Krenk et al
2 Increased long-term mortality after a high perioperative oxygen fraction during abdominal surgery v/ Christian S. Meyhoff et al
9 Effect of high-dose methylprednisolone on pain and recovery in total knee arthroplasty:
A randomized, double-blind, placebo-controlled trial v/ Troels H. Lunn et al
13 Lung recruitment affects frontal lobe oxygenation in cardiac surgical patients v/ Lars Møller Pedersen et al
12.00 - 12.45 Udstilling - sandwich/vand i udstillingsområdet 12.00 - 12.45 Denmark Room
Frokostsymposium - Norpharma 12.45 - 14.15 Norway Room
Nye guidelines for genoplivning 2010
v/ Dan Isbye, Freddy Lippert og Torsten Lauritsen Moderator: Troels Martin Hansen
Iceland Room Neuroinfektioner v/ Diederik van de Beek Moderator: Kirsten Møller Finland Room
Ledelse, uddannelse og struktur - kan læger forbedres når systemet forandres?
- Ledende læger strukturerer den gode uddannelse v/ Anne Marie Ulrik
- Læger leder efter struktur i uddannelsen - leder strukturændringer lægers videreuddannelse på vej?
v/ Morten G. Poulsen
- Lægelig uddannelse og ledelse ændrer struktur for (patient-)sikkerhedens skyld v/ Kim Garde Moderator: Anne Lippert
12.45 - 14.15 Sweden Room
(fortsat) Kroniske smerter efter kirurgi, prædiktion og forebyggelse v/ Lone Nikolajsen, Eske Aasvang og Kim Wildgaard Moderator: Luana L. Jensen
14.15 - 14.40 Udstilling - kaffe 14.40 - 15.10 Norway Room
Tracheal intubation in patients with cervical spine problems v/ Rafi Avitsian
Moderator: Karsten Bülow Sweden Room
Damage control ved milt- og levertraumet v/ Jens Hillingsø
Moderator: Lone M. Poulsen Denmark Room
Systematisk/teoretisk/praktisk oplæring i ultralydsvejledt blokanlæggelse v/ Søren Bøgevig og Anders Rothe
Moderator: Jens Børglum Finland Room
Patientskader som følge af anæstesi v/ Lars Hove
Moderator: Lars S. Rasmussen 15.10 - 15.15 Kort pause
15.15 - 15.45 Norway Room
Steroid og neuroinfektioner v/ Diederik van de Beek Moderator: Kirsten Møller Sweden Room
Cuffed vs. uncuffed tubes v/ Markus Weiss
Moderator: Rolf Holm-Knudsen Denmark Room
Præhospital ultralyd v/ Claus Valther Rohde Moderator: Søren Mikkelsen Finland Room
Måling af cardiac output - hvor er fejlkilderne?
v/ Poul Lunau Christensen Moderator: Henning Bay Nielsen 15.45 - 18.00 PAUSE
18.00 - 19.00 Norway Room
Den 42. Husfeldt-forelæsning:
Præhospital pioner
v/ Mogens Bredgaard Sørensen Moderator: Susanne Wammen 19.00 - 02.00 Middag, revy, prisoverrækkelser, fest
Fredag d. 12. november fortsat
Lørdag d. 13. november
Foredragsholdere og mødeledere
• Andersen, Claus, overlæge, anæstesi- og intensivafd., Odense Universitetshospital
• Andersen, Lars Willy, overlæge, dr.med., thoraxanæstesiologisk klinik, HJE, Rigshospitalet
• Andersen, Lasse Østergaard, læge, anæstesiafd., Hvidovre Hospital
• Antonsen, Kristian, overlæge, anæstesiafd., Hillerød Hospital
• Avitsian, Ravi, professor, MD, Section Head, Anesthesiology Institute, The Cleveland Clinic
• Barfod, Charlotte, afd.læge, anæstesiafd., Hillerød Hospital
• Berlac, Peter A., ledende overlæge, akutafd., Hillerød Hospital
• Brandstrup, Birgitte, afd.læge, operations- og anæstesiafd., Glostrup Hospital
• Bundgaard, Morten, læge, anæstesiafd., Hvidovre Hospital
• Bøgevig, Søren, læge, anæstesiafd., Bispebjerg Hospital
• Børglum, Jens, overlæge, ph.d., anæstesiafd., Bispebjerg Hospital
• Bülow, Karsten, overlæge, anæstesi- og intensivafd., Odense Universitetshospital
• Callesen, Torben, klinikchef, overlæge, dr.med., anæstesi- og operationsklinikken, ABD, Rigshospitalet
• Christensen, Poul Lunau, overlæge, anæstesiafd., Bispebjerg Hospital 08.45 - Registrering
09.00 - 09.45 Norway Room Diabetes på intensiv
v/ Else Tønnesen og Steen Madsbad Moderator: Marianne Simonsen Finland Room
Vil “transversus abdominis plane” (TAP) block erstatte epidural - og hvad er det?
v/ Pernille Lykke Pedersen Moderator: Egon G. Hansen 09.45 - 10.00 Kaffepause
10.00 - 11.30 Finland Room
Den alkoholiserede eller intoxikerede intensivpatient Janne Tolstrup og Peter Skanning
Moderator: Susanne Iversen Norway Room
Nordisk anbefaling for anæstesi til akutte patienter
v/ Anders Gadegaard Jensen, Ann Møller og Torben Callesen Moderator: Birgitte Ruhnau
11.30 - 12.15 Frokost 12.15 - 13.15 Finland Room
Steroids - pulmonary effects v/
Moderator: Nanna Reiter og Kristian Antonsen Norway Room
Store ændringer på akutområdet v/
Moderator:
13.15 - 14.00 Norway Room
Den Danske Kvalitetsmodel v/ Kjeld Møller Pedersen Moderator: Ole Nørregaard
• Felsby, Sven, overlæge, anæstesi- og intensivafd., Århus Universitetshospital, Skejby
• Fomsgaard, Jonna Storm, overlæge, operations- og anæstesiafd., Glostrup Hospital
• Gaarde, Kim, ledende overlæge, anæstesiafd., Næstved Sygehus
• Giebner, Matthias, overlæge, Falck A/S
• Gilbert, Mads, overlæge, dr.med., Universitetssykehuset Nord-Norge
• Greisen, Gorm, professor, overlæge, dr.med., neonatalklinikken, JMC, Rigshospitalet
• Hansen, Egon G., overlæge, SDL, anæstesiafd., Herlev Hospital
• Hansen, Tom G., overlæge, anæstesi- og intensivafd., Odense Universitetshospital
• Hansen, Troels Martin, overlæge, lægeambulancen i Århus, Århus Universitetshospital
• Haure, Pernille, overlæge, anæstesi- og intensivafd., Ålborg Sygehus
• Hillingsø, Jens, klinikchef, overlæge, ph.d., kir. gastro. klinik CTX, Rigshospitalet
• Holm-Knudsen, Rolf, overlæge, anæstesi- og operationsklinikken, HOC, Rigshospitalet
• Hove, Lars D, overlæge, anæstsiafd., Hvidovre Hospital
• Hyllested, Mette, overlæge, anæstesiafd., Bispebjerg Hospital
• Isbye, Dan, læge, anæstesi- og operationsklinikken, JMC, Rigshospitalet
• Iversen, Susanne, overlæge, anæstesi- og intensivafd., Slagelse Sygehus
• Jans, Øivind, læge, enhed for kirurgisk patofysiologi, JMC, Rigshospitalet
• Jansen, Erik C., overlæge, anæstesi- og operationsklinikken, HOC, Rigshospitalet
• Jensen, Anders Gadegaard, overlæge, dr.med., anæstesi- og intensivafd., Odense Universitetshospital
• Jensen, Luana L., overlæge, anæstesi- og intensivafd., Århus Universitetshospital, Skejby
• Kehlet, Henrik, professor, overlæge, dr.med., enhed for kirurgisk patofysiologi, JMC, Rigshospitalet
• Kirkegaard, Hans, overlæge, dr.med., anæstesi- og intensivafd., Århus Universitetshospital, Skejby
• Kjærgaard, Benedict, overlæge, thoraxkirurgisk afd., Ålborg Sygehus
• Kurita, Geana, projektsygeplejerske, enhed for akut smertebehandling og palliation, HOC, Rigshospitalet
• Larsen, Ulf Thyge, overlæge, anæstesi- og intensivafd., Århus Universitetshospital, Skejby
• Laugesen, Helle, overlæge, anæstesi- og intensivafd., Ålborg Sygehus
• Lauritsen, Torsten, overlæge, anæstesi- og operationsklinikken, JMC, Rigshospitalet
• Lippert, Anne, overlæge, DIMS, Herlev Hospital
• Lippert, Freddy, overlæge, enhed for akut medicin og sundhedsberedskab, Region Hovedstaden
• Madsbad, Steen, professor, overlæge, dr.med., endokrinologisk afd., Hvidovre Hospital
• Mikkelsen, Søren, overlæge, anæstesi- og intensivafd., Odense Universitetshospital
• Møller, Ann, overlæge, dr.med., anæstesiafd., Herlev Hospital
• Møller, Kirsten, overlæge, dr.med., anæstesiafd., Bispebjerg Hospital
• Nielsen, Henning Bay, overlæge, dr.med., anæstesi- og operationsklinikken, ABD, Rigshospitalet
• Nikolajsen, Lone, forskningsoverlæge, anæstesi- og intensivafd., Århus Universitetshospital
• Nørregaard, Ole, overlæge, anæstesi- og intensivafd., Århus Universitetshospital
• Pedersen, Pernille Lykke, afd.læge, operations- og anæstesiafd., Glostrup Hospital
• Pedersen, Kjeld Møller, professor, cand.oecon, Syddansk Universitet
• Pott, Frank, overlæge, anæstesiafd., Bispebjerg Hospital
• Poulsen, Lone, overlæge, anæstesiafd., Sygehus Nord, Køge Sygehus
• Poulsen, Morten Gustav, afd.læge, anæstesi- og intensivafd., Århus Universitetshospital
• Rasmussen, Bodil Steen, overlæge, anæstesi- og intensivafd., Ålborg Sygehus
• Rasmussen, Lars S., professor, overlæge, dr.med., anæstesi- og operationsklinikken, HOC, Rigshospitalet
• Reiter, Nanna, afd.læge, ITA, ABD, Rigshospitalet
• Rohde, Claus Valter, afd.læge, lægeambulancen i Århus, anæstesiafd., Århus Universitetshospital
• Rothe, Anders, læge, anæstesiafd., Bispebjerg Hospital
• Ruhnau, Birgitte, overlæge, anæstesi- og operationsklinikken, ABD, Rigshospitalet
• Schønnemann, Niels Kim, overlæge, anæstesi- og intensivafd., Århus Universitetshospital
• Secher, Niels Henry, professor, overlæge, dr.med., anæstesi- og operationsklinikken, ABD, Rigshospitalet
• Severinsen, Inge Krogh, overlæge, anæstesi- og intensivafd., Århus Universitetshospital, Skejby
• Simonsen, Marianne, overlæge, anæstesi- og intensivafd., Århus Universitetshospital
• Skanning, Peter, overlæge, Giftlinien, anæstesiologisk afd., Bispebjerg Hospital
• Sloth, Erik, professor, overlæge, dr.med., anæstesi- og intensivafd., Århus Universitetshospital, Skejby
• Sørensen, Mogens Bredgaard, docent, overlæge, dr.med.
• Thomsen, Annemarie Bondegaard, overlæge, anæstesi- og operationsklinikken, HOC, Rigshospitalet
• Tingleff, Jens, overlæge, Vordingborg Kaserne , DANILOG og Gentofte Hospital
• Toft, Palle, professor, overlæge, dr.med., anæstesi- og intensivafd., Odense Universitetshospital
• Tollund, Carsten, overlæge, anæstesi- og operationsklinikken, ABD, Rigshospitalet
• Tolstrup, Janne, forskningsleder, ph.d., Statens Institut for Folkesundhed, Syddansk Universitet
• Tønnesen, Else K., professor, overlæge, dr.med., anæstesi- og intensivafd., Århus Universitetshospital
• Ulrich, Annette Gaardøje, overlæge, thoraxanæstesiologisk klinik, HJE, Rigshospitalet
• Ulrik, Anne Marie, overlæge, Sygehus Sønderjylland
• Wammen, Susanne, overlæge, anæstesi- og operationsklinikken, HOC, Rigshospitalet
• Weiss, Markus, professor, MD, Head Department of Anaesthesia, University Children’s Hospital, Zürich, Schweiz
• Wildgaard, Kim, læge, enhed for kirurgisk patofysiologi, JMC, Rigshospitalet
• Aasvang, Eske Kvanner, læge, thoraxanæstesiologisk klinik, HJE, Rigshospitalet
Foredragsholdere og mødeledere fortsat
Abstracts - ACTA Foredragskonkurrence
11: Førsteforfatter: Troels Haxholdt Lunn E-mail: lunn@dadlnet.dk
Afdeling: Dep. of Anaesthesiology and The Lundbeck Centre for Fast- track Hip and Knee Arthroplasty
Hospital/Sygehus: Hvidovre Hospital
Medforfattere: Billy B. Kristensen, Henrik Husted, Søren Solgaard, Kristian Otte, Anne Grete Kjersgaard, Lissi Gaarn-Larsen, Henrik Kehlet LocAL INFILtRAtIoN ANALgESIA FoR AcutE pAIN RELIEF IN HIp ARtHRopLASty: Do wE NEED It? A RANDoMIzED, DouBLE- BLIND, pLAcEBo-coNtRoLLED tRIAL IN 120 pAtIENtS
Introduction: High-volumen local infiltration analgesia (LIA) is widely applied in many European centers as part of a multimodal pain manage- ment strategy in total hip arthroplasty (THA). However, methodologi- cal problems hinder exact interpretation of previous trials, and the evidence for LIA in THA is questionable. We aimed to evaluate if intra- operative high-volume LIA, in addition to a multimodal oral analgesic regime, would further reduce acute postoperative pain after THA.
Methods: Ethics committee approval was granted. One hundred twenty patients scheduled for unilateral, primary THA using spinal anaesthesia were included in this randomized, double-blind, placebo-controlled trial receiving high-volume (150 ml) infiltration with ropivacaine 0.2% with epinephrine (10µg ml-1) or saline 0.9% in the wound intraoperatively.
The multimodal oral analgesic regime was instituted preoperatively and consisted of slow release acetaminophen 2g, celecoxib 400mg and gabapentin 600mg. Rescue analgesic consisted of oral oxycodone. The primary endpoint was pain during walking (5 meters) 8h after surgery.
Secondary endpoints were pain at rest, pain upon 45° flexion of the hip with straight leg and cumulated consumption of oxycodone. Pain was assessed repeatedly the first 8h after surgery using the 100mm visual analog scale. Non-parametric statistics with post hoc Bonferroni correction for repeated measures was applied.
Results: Pain scores were low for all pain assessments and did not differ between the ropivacaine and the placebo group (p>0.05).
Consumption of rescue oxycodone and summarized (added) pain scores (2-8h) did not differ between groups (p>0.05).
Discussion: This study demonstrated that a multimodal oral analgesic regime with gabapentin, celecoxib and acetaminophen caused low acute postoperative pain following THA, and LIA did not further improve analgesia. We consider it unlikely that repeatedly, postoperative injec- tions with local anaesthetic via an intraarticular catheter (as applied by many) have an analgesic effect, when is it is not the case for the sys- tematic intraoperative infiltration. Positive results reported in previous trials may be due to a systemic analgesic effect of NSAID added to the LIA-mixture (but not in the control group). We cannot rule out that LIA may have an analgesic effect with a less comprehensive oral regime or in selected patients (high pain responders).
conclusion: Intraoperative high-volume LIA with ropivacaine 0.2%
provided no additional reduction in acute postoperative pain after THA when combined with a multimodal oral analgesic regime consisting of gabapentin, celecoxib and acetaminophen and is therefore not recommended.
1: INtuBAtIoN IN MoRBIDLy oBESE pAtIENtS.
A RANDoMISED coNtRoLLED StuDy coMpARINg tHE gLIDE- ScopE® VIDEoLARyNgoScopE AND MAcINtoSH DIREct LARyNgoScopE.
Authors: Lasse Høgh Andersen lasse.andersen@dadlnet.dk, L. Rovsing, J. Sylvestersen, K. S. Olsen, Glostrup Hospital.
Introduction: Morbidly obese patients (BMI >35 kg/m²) are at in- creased risk during tracheal intubation due to an increased frequency of difficult mask ventilation, a high Cormack-Lehane (C-L) grade (1), and a decreased apnoea tolerance (2). Consequently these patients are especially dependant on a fast and safe airway management.
The GlideScope® videolaryngoscope (GSVL) has been shown to improve the laryngoscopic view especially in patients with a high C-L grade (3).
Our purpose was to compare the GSVL and the Macintosh direct laryngo- scope (MDL) as to time spent, C-L grade and intubation difficulty in obese patients.
Methods: 100 consecutive patients, BMI >35 kg/m², scheduled for bariatric surgery, were randomised to group GSVL or group MDL.
All patients were intubated placed in the ramped position, 30° anti Trendelenburg with 5 minutes of preoxygenation. All intubations were performed by one of five anaesthetists experienced in using both de- vices. Time from griping the device to successful intubation, number of attempts, desaturation (SATO2 < 95%), C-L grade, significant bleeding in upper airway, validated Intubation Difficulty Scale (IDS), postopera- tive sore throat and hoarseness were registered.
Results: The two groups were comparable as to sex, age, BMI, Mallampati score, neck circumference and history of sleep apnoea.
They differed significantly in three parameters. The GSVL/MDL mean intubation time was 51/38 sec, SD± 23/24 (range 22 - 148/17 - 148) (p=0.0001). The C-L grade 1/2/3/4 (n) for GSVL/MDL was 35/13/2/0 / 23/13/10/4 (p=0.003). The median IDS for GSVL/MDL was 2/1 (p=0.03).
No other significant differences were registered. However, two cases of failed intubation were registered in the MDL group. Both patients were intubated with the GSVL without problems.
Discussion: Our study showed that intubation using the MDL is slightly faster compared to the GSVL. However, intubation using the GSVL did not cause any incidents with desaturation. We found that the GSVL provided a lower C-L grade and slightly decreased IDS.
In most morbidly obese patients a standard MDL seems to be a safe first choice. However the GSVL seems to be preferable especially for patients with an expected or known high C-L grade.
conclusion: The median intubation time was significantly faster using the MDL, but both IDS score and C-L grade was significantly lower using the GSVL.
References:
1. Incidence and Predictors of Difficult and Impossible Mask Ventilation.
Anesth. 2006; 105:885-91
2. Effect of Obesity on Safe Duration of Apnea in Anesthetizied Humans.
Anesth. Anal. 1991; 72:89-93
3. Early clinical experience with a new videolaryngoscope (Glide- scope®) in 728 patients. Can J Anaesth 2005;52(2):191-8
14: Førsteforfatter: Lene Krenk E-mail: Lene.krenk@rh.regionh.dk Afdeling: Afd. 4231
Hospital/Sygehus: Rigshospitalet
Medforfattere: Henrik Kehlet, Poul Jennum
poStopERAtIVE SLEEp DIStuRBANcES AFtER FASt-tRAcK HIp AND KNEE REpLAcEMENt
Introduction: Immediately after major surgery REM sleep is severely impaired1 and may contribute to early fatigue and cognitive dysfunction.
The pathogenesis is unknown but postoperative pain, opioids, systemic inflammation and length of hospital stay (LOS) may contribute.2 Previous studies with traditional LOS of about 10 days and use of opioids have shown marked decrease in REM sleep on the first postoperative night with a rebound phenomenon on the following two nights.1
The aim of this study was for the first time to illustrate sleep distur- bances after fast-track hip and knee replacement (THA and TKA) with opioid sparing multimodal analgesia (Gabapentin, Celecoxib, Paracetamol and high-volume local wound infiltration analgesia (LIA)).
Methods: 6 patients (mean 68 years) undergoing fast-track THA or TKA with opioid sparing multimodal analgesia underwent continuous polysomnographic monitoring (PSG) one night preoperatively in their own home (baseline), continuously during their hospital stay and again on the fourth or fifth postoperative night at home. Sleep was scored according to the AASM Manual for Scoring of Sleep and Associated Events.3 The study was approved by the Ethics Committee.
Results: On the first postoperative night the proportion of REM sleep was significantly reduced (preoperatively mean 16%, postoperatively mean 1.5% (P = 0.02)). No REM sleep was apparent during daytime sleep while hospitalised. REM sleep was normal on the fourth post- operative night (mean 18.8%). Mean LOS was 1.6 days (range 1-2 days).
Morfin use during hospitalisation was median 20 mg a day.
Discussion: The present fast-track set-up with limited opioid use together with LOS of 1-2 days compared with about 10 days in pre- vious studies did not rectify the pronounced postoperative REM sleep disturbances. However, the severe early REM sleep disturbances was normalised on the fourth postoperative night. Based on our findings future studies on postoperative sleep disturbances should focus on the role of environmental factors (noise, monitoring etc.), the inflammatory response (IL-6) and opioid free analgesia.2
conclusion: Despite a fast-track opioid sparing set-up for THA and TKA REM sleep is severely reduced during the first postoperative night but is normalized on the fourth postoperative night.
References
1. Rosenberg J et al. Late postoperative nocturnal episodic hypoxae- mia and associated sleep pattern. Br J Anaesth 1994; 72: 145-150.
2. Krenk L, Rasmussen LS, Kehlet H. New insights into the pathophysi- ology of postoperative cognitive dysfunction. Acta Anaesth Scand 2010; e-pub.
3. The AASM Manual for the Scoring of Sleep and Associated Events:
Rules, Terminology and Technical Specifications. American Academy of Sleep Medicine 2007.
2: Førsteforfatter: Christian S. Meyhoff E-mail: christianmeyhoff@gmail.com
Afdeling: Anæstesi- og operationsklinikken, 4231, HOC Hospital/Sygehus: Rigshospitalet
Medforfattere: Anne Marie Møller, Lars Nannestad Jørgensen, Jørn Wetterslev, Janne Hammer, Kirsten Møller, Lars S. Rasmussen INcREASED LoNg-tERM MoRtALIty AFtER A HIgH pERI- opERAtIVE oxygEN FRActIoN DuRINg ABDoMINAL SuRgERy Introduction: A high perioperative inspiratory oxygen fraction (80%) has been recommended to prevent postoperative wound infections [1].
However, the largest and most recent trial, the PROXI Trial [2], found no reduction in surgical site infection and a tendency towards higher 30-day mortality in patients given 80% oxygen compared to patients given 30% oxygen [3]. The aim of this follow-up study of the PROXI Trial was to assess the association between long-term mortality and perioperative oxygen fraction in patients undergoing abdominal surgery.
Methods: The Danish Medicines Agency and the regional ethics com- mittee approved the trial (NCT00364741). From October 8, 2006 to October 6, 2008, a total of 1,386 patients underwent acute or elective laparotomy and were randomized to receive either 80% oxygen or 30% oxygen during and for two hours after surgery. Follow-up date was February 24, 2010. Survival was analyzed using Kaplan-Meier statistics and Cox proportional hazards model.
Results: Vital status was obtained in 1,382 of 1,386 patients after a median follow-up of 2.3 years (range 1.3 to 3.4 years). Mortality was significantly higher in patients assigned to 80% oxygen compared to patients assigned to 30% oxygen (hazards ratio 1.28; 95% confidence interval 1.01 - 1.62; P = 0.04; Figure 1). The risk of a type 1 error was even smaller among the 714 patients undergoing cancer surgery (hazards ratio 1.41; 95% confidence interval 1.07 - 1.85; P = 0.02; Figure 2).
Discussion and conclusion: Administration of 80% oxygen in the perioperative period is associated with significantly increased long- term mortality and this seems to be consistent in both patients given 80% oxygen during cancer surgery and non-cancer surgery.
Figure 1: Overall survival after abdominal surgery
Figure 2: Survival after abdominal cancer surgery
References: 1) Quadan M et al. Arch Surg 2009;144:359-66.
2) Meyhoff CS et al. Trials 2008;9:58. 3) Meyhoff CS et al. JAMA 2009;302:1543-50.
Abstracts - ACTA Foredragskonkurrence
9: Førsteforfatter: Troels Haxholdt Lunn E-mail: lunn@dadlnet.dk
Afdeling: Dep. of Anaesthesiology and The Lundbeck Centre for Fast- track Hip and Knee Arthroplasty
Hospital/Sygehus: Hvidovre Hospital
Medforfattere: Billy B. Kristensen, Lasse Ø. Andesen, Henrik Husted, Kristian Otte, Lissi Gaarn-Larsen, Henrik Kehlet
EFFEct oF HIgH-DoSE MEtHyLpREDNISoLoNE oN pAIN AND REcoVERy IN totAL KNEE ARtHRopLASty: A RANDoMIzED, DouBLE-BLIND, pLAcEBo-coNtRoLLED tRIAL
Introduction: Total knee arthroplasty (TKA) is associated with severe pain despite an extensive, multimodal analgesic approach, but the effect of high-dose glucocorticoid administration has not been studied.
We hypothesized that a single, high, preoperative dose of methylpred- nisolone (MP) would improve analgesia during walking 24h after TKA.
Methods: Ethics committee approval was granted. Patients scheduled for unilateral, primary TKA using spinal anaesthesia were consecutively included in a randomized, double-blind, placebo-controlled trial receiving preoperative MP 125 mg IV or placebo (saline). All patients received a standardized, multimodal analgesic regime including oral acetami- nophen, celecoxib and gabapentin and intra-operative local infiltration analgesia. Rescue analgesics consisted of intravenous sufentanil in the Post-Anesthesia Care Unit (PACU) and of oral oxycodone in the ward. The primary endpoint was pain during walking (5 meters) 24h after surgery, and secondary endpoints were pain at rest, pain upon 45° flexion of the hip with straight leg, and pain upon 45° knee flexion.
Assessment was performed using the visual analog scale preopera-
tively and repeatedly during the first 48h after surgery, as well as in a questionnaire from day 2 to 10, and at follow up on day 21 and day 30.
Tertiary endpoints were postoperative nausea and vomiting (PONV), C-reactive protein (CRP), fatigue, sleep quality, and rescue analgesic- and antiemetic requirements. Non-parametric statistics with post hoc Bonferroni correction for repeated measures was applied.
Results: Forty-eight included patients all completed the trial. Pain during walking was significantly lower in the MP group up to 32h postoperatively. Summarized pain scores (2-48h) were lower for all pain assessments (during walking; at rest; upon hip flexion; and upon knee flexion) (p<0.02). Fewer patients required sufentanil in the PACU (p<0.02), and consumption of oxycodone was lower from 0-24h (p<0.01). PONV and consumption of antiemetic was reduced (p<0.05), and CRP was lower at 24h (p<0.0001). Fatigue throughout the day of operation was lower (p=0.04), but sleep quality was worse the first postoperative night (p=0.01). No side effects or complications were observed in other respects, and no prolonged improvements were found on later recovery throughout the 30-day period.
Discussion: This study demonstrates that high-dose MP improves postoperative analgesia and immediate recovery after TKA, possibly by suppressing the inflammatory response. It was not powered regarding final evaluation of sub-acute outcomes and safety. Thus our findings call for further studies on a larger scale.
conclusion: MP 125 mg before surgery improves postoperative analgesia and immediate recovery after TKA, even when combined with an extensive, multimodal analgesic regime.
13: Førsteforfatter: Lars Møller Pedersen E-mail: larsmoellerp@gmail.com
Afdeling: Anæstesiologisk Afdeling Hospital/Sygehus: Hvidovre Hospital
Medforfattere: Jonas Nielsen, Morten Østergaard, Eigil Nygård, Henning Bay Nielsen
LuNg REcRuItMENt AFFEctS FRoNtAL LoBE oxygENAtIoN IN cARDIAc SuRgIcAL pAtIENtS
Background: A lung recruitment maneuver (LRM) may cause hypoten- sion and as cerebral O2 delivery depends on mean arterial pressure (MAP), this study evaluates the level of cerebral desaturation provoked by LRM.
Methods: Following on-pump coronary artery bypass graft surgery in ten patients (age 64 ± 10 yr, euroscore 4 ± 2), near infrared spectroscopy determined frontal lobe oxygenation was assessed during LRM applied at 40 cm H2O for 20 s.
Results: In response to LRM, cardiac output decreased and MAP was reduced from 69 ± 7 to 55 ± 11 mmHg with an increase in arterial O2
pressure from 29 ± 15 to 40 ± 12 (P < 0.05). Frontal lobe oxygenation decreased from 68 ± 3 to 60 ± 4 % (P < 0.05) with cerebral desatura- tion in eight patients while
in two patients frontal lobe oxygenation did not change during LRM.
With a decrease in MAP by 10 mmHg, frontal lobe oxygenation was maintained within 5 % of the pre-LRM value and when MAP decreased more than 10 mmHg, cerebral desatura- tion exceeded 10 %. Thus, during LRM, the change in frontal lobe oxygenation correlated to MAP (r2 = 0.57;
P < 0.05) and to cardiac output (r2 = 0.40; P < 0.05).
Within one minute from termination of LRM, MAP, cardiac output and frontal
lobe oxygenation returned to the pre-LRM levels.
conclusions: Following on-pump coronary artery bypass graft surgery, lung recruitment maneuver reduces frontal lobe oxygenation and with development of hypotension lung recruitment maneuver should be aborted.
13: Førsteforfatter: Lars Møller Pedersen
E-mail: larsmoellerp@gmail.com Afdeling: Anæstesiologisk Afdeling Hospital/Sygehus: Hvidovre Hospital
Medforfattere: Jonas Nielsen, Morten Østergaard, Eigil Nygård, Henning Bay Nielsen Overskrift: Lung recruitment affects frontal lobe oxygenation in cardiac surgical patients Background: A lung recruitment maneuver (LRM) may cause hypotension and as cerebral O2 delivery depends on mean arterial pressure (MAP), this study evaluates the level of cerebral desaturation provoked by LRM.
Methods: Following on-pump coronary artery bypass graft surgery in ten patients (age 64 ± 10 yr, euroscore 4 ± 2), near infrared spectroscopy determined frontal lobe oxygenation was assessed during LRM applied at 40 cm H2O for 20 s.
Results: In response to LRM, cardiac output decreased and MAP was reduced from 69 ± 7 to 55 ± 11 mmHg with an increase in arterial O2 pressure from 29 ± 15 to 40 ± 12 (P < 0.05). Frontal lobe oxygenation decreased from 68 ± 3 to 60 ± 4 % (P < 0.05) with cerebral desaturation in eight patients while in two patients frontal lobe oxygenation did not change during LRM. With a decrease in MAP by 10 mmHg, frontal lobe oxygenation was maintained within 5 % of the pre-LRM value and when MAP decreased more than 10 mmHg, cerebral desaturation exceeded 10 %. Thus, during LRM, the change in frontal lobe oxygenation correlated to MAP (r2 = 0.57; P < 0.05) and to cardiac output (r2 = 0.40; P < 0.05). Within one minute from termination of LRM, MAP, cardiac output and frontal lobe oxygenation returned to the pre-LRM levels.
Conclusions: Following on-pump coronary artery bypass graft surgery, lung recruitment maneuver reduces frontal lobe oxygenation and with development of hypotension lung recruitment maneuver should be aborted.
